Powering the UK’s response to AMR Powering the UK’s response to AMR Claudia Martínez September 2020 #reformhealth 0 Powering the UK’s response to AMR Acknowledgements Reform would like to thank BD (Becton, Dickinson and Company) for kindly supporting this paper. External reviewers The authors would like to thank Professor Hilary Thomas, Director and Chief Medical Adviser at KPMG, for helpful comments on an earlier draft of this paper. Interviewees The authors would like to express their gratitude to the 11 individuals and organisations who were interviewed as part of the research for this paper and kindly agreed to be acknowledged: Adam Zerda, Director, AMR Strategy & Development, BD. Arlene Brailey, Patient Support Officer, Antibiotic Research UK. Professor Colin Garner, Chief Executive, Antibiotic Research UK. Dr Roger Harrison, Senior Lecturer in Public Health, Centre for Epidemiology, University of Manchester. Jeremy Knox, Policy & Advocacy Lead Drug-Resistant Infections, Wellcome Trust. Jessica Morley, Policy Lead, Evidence-Based Medicine, Data Lab University of Oxford. Liz Cross, Advanced Nurse Practitioner, Attenborough Surgery, Bushey Medical Centre. Michael Corley, Head of Policy & Public Affairs, British Society for Antimicrobial Chemotherapy. Rose Gallagher, Professional Lead Infection Prevention & Control, Royal College of Nursing. Pat Cattini, President, Infection Prevention Society. Professor Dame Sally Davies, UK Special Envoy on Antimicrobial Resistance. Icon in logo made by Good Ware from www.flaticon.com 1 Powering the UK’s response to AMR About Reform is established as the leading Westminster think tank for public service reform. We are dedicated to achieving better and smarter public services. Our mission is to set out ideas that will improve public services for all and deliver value for money. We work on core sectors such as health and social care, education, home affairs and justice, and work and pensions. Our work also covers issues that cut across these sectors, including public service design and delivery and digital public services. We are determinedly independent and strictly non-party in our approach. Reform is a registered charity, the Reform Research Trust, charity no.1103739. This publication is the property of the Reform Research Trust. The arguments and any errors that remain are the authors’ and the authors’ alone. About Reform Ideas Reform Ideas – These are short research papers which enable a high-level exploration of a key public service challenge. The papers examine the policy context, identify key opportunities for reform and set a vision for the future. 2 Powering the UK’s response to AMR Contents Foreword ....................................................................................................................... 4 Ideas ............................................................................................................................. 5 Introduction ................................................................................................................... 7 1. AMR and the ‘post-antibiotic’ world ........................................................................ 8 1.1 AMR: A brief definition ................................................................................... 8 1.2 The global AMR effort: Stalled progress? ...................................................... 9 1.3 The UK’s AMR response ............................................................................. 10 1.4 COVID-19 and its impact on drug-resistance ............................................... 13 2. Time for action ..................................................................................................... 15 2.1 Transforming antibiotics R&D ...................................................................... 15 2.2 Rethinking the financial model ..................................................................... 16 2.3 Recognising the value of vaccines ............................................................... 17 2.4 Embedding infection prevention & control in everyday practice.................... 19 2.5 Harnessing the power of diagnostic tools ..................................................... 20 2.5.1. Bringing new diagnostic tools to market ............................................... 20 2.5.2. Developing a value-based approach to diagnostics ............................. 21 2.5.3. Making use of current technology & improving current practice ............ 22 2.6 Building the right capability and skills ........................................................... 23 2.7 Turning surveillance data into actionable insights ........................................ 25 2.8 Making AMR everyone’s business ............................................................... 26 2.8.1. Reframing AMR ................................................................................... 28 2.8.2. Tapping into the “power of the crowd” .................................................. 29 2.9 Mobilising political action & creating a mandate for change ......................... 30 Conclusion .................................................................................................................. 32 Glossary ....................................................................................................................... 34 Bibliography ................................................................................................................ 36 3 Powering the UK’s response to AMR Foreword The future of modern medicine depends on antibiotics. Yet, the future of global health could be undermined by Antimicrobial Resistance (AMR). AMR is happening now in all countries, but it is preventable if we act now, collaboratively across borders and sectors. AMR is a top national priority for the UK, as it is for the World Health Organisation, World Economic Forum and United Nations. I am proud of the impressive progress the UK has made in tackling AMR and securing AMR on the global agenda in recent years. We have significantly reduced antibiotic use in humans and the animal sector and continue to take action to protect the antibiotics we already have by ensuring they are only used when needed. We have built world-leading surveillance and research capabilities to help us better understand drug-resistant infections and support the development of innovative ideas and technologies. We are at the forefront of tackling AMR globally. This June, the UK launched a pioneering, world-first payment scheme to encourage industry to develop much-needed antibiotics for NHS patients. These are all important steps forward to meet our commitments in our National Action Plan and our ambitions in our 20 Year Vision for AMR. Our challenge is now to build on this momentum by ensuring that commitments translate into concrete action globally, on the ground, and encouraging other countries to join the UK in similar innovative ventures. As attention turns to building back our health systems and economies from COVID-19, we must also build our resilience to tackle AMR. Without sufficient and timely action worldwide, drug resistance will have deeper and even farther-reaching consequences for all countries’ health systems and the world economy than COVID-19 is having. The world must step up preventative efforts, through hygiene and vaccination, the role of fast diagnostics and therapies, and the need for better monitoring and stewardship of the use of antimicrobials. It is against this backdrop that I welcome Reform’s new report looking at the UK's role and contribution to the global response on AMR. It is not only timely but of utmost importance that we continue to show global leadership in addressing this global health issue and lead the way for other countries to join us. We must all move forward together. Professor Dame Sally Davies, UK Special Envoy on AMR 4 Powering the UK’s response to AMR Ideas Idea 1: The Department for Health and Social Care, in partnership with relevant local and international stakeholders, should develop an engagement plan to strengthen policymaker’s, healthcare professionals’ and the public’s understanding of the impact of vaccines on antimicrobial stewardship and their role in addressing AMR. These efforts should be built on robust analyses and modelling of the health and economic impacts of immunisation on antibiotic use, and improved surveillance data on the effects that vaccine uptake has in limiting the burden of AMR. Idea 2: NHS England and NHS Improvement, in collaboration with the National Institute for Health and Care Excellence, should urgently commission a national assessment of the clinical and cost-effectiveness of tools like point-of-care diagnostics to inform future reimbursement models. The assessment should consider tests’ performance across health and care settings, as well as additional dimensions of value such as clinical outcomes and impact on clinical workflows. Specific measurements to assess the value these tools provide with regard to their impact on AMR should be explored. Idea 3: The AMR Diagnostic Partnership Board should focus on improving existing practice and closing well-recognized gaps in clinical care. One such example would be to support the widescale adoption of the national standards for blood culture processing issued by Public Health England and the pathways produced by National Institute for Care Excellence (NICE) pathways across NHS Trusts. Idea 4: Health Education England should evaluate strategies to ensure that the